Volume 5, Number 12
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Monday, March 28, 2005
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Retinopathy and
Risk of Congestive Heart Failure Congestive heart failure (CHF) affects a substantial proportion of adults, including those without preexisting coronary heart disease. The pathogenesis of CHF is uncertain, but microvascular disease has been named as a possible factor. A population-based, prospective seven-year cohort study conducted by the Center for Eye Research Australia at the University of Melbourne, aimed to determine the relationship of retinopathy, a marker of systemic microvascular disease, to risk of CHF. The study was held in four U.S. communities using the Atherosclerosis Risk in Communities Study database. A total of 11,612 participants aged 49 to 73 years had retinal photographs taken between 1993 and 1995. The photographs were graded according to a standardized protocol for the presence of retinopathy (microaneurysms, retinal hemorrhages, soft exudates), arteriovenous nicking, focal arteriolar narrowing and generalized arteriolar narrowing. The seven-year cumulative incidence of CHF was 5.4 percent (492 events). Participants with retinopathy had a higher incidence of CHF compared with those without retinopathy (15.1 percent vs. 4.8 percent). After controlling for age, sex, race, preexisting coronary heart disease, mean arterial blood pressure, diabetes, glucose level, cholesterol level, smoking, body mass index and study site, researchers found that the presence of retinopathy was associated with a twofold higher risk of CHF (relative risk, 1.96; 95 percent confidence interval, 1.51 to 2.54). Among participants without preexisting coronary heart disease, diabetes or hypertension, retinopathy was associated with a threefold higher risk of CHF (relative risk, 2.98; 95 percent CI, 1.50 to 5.92). Investigators concluded that retinopathy is an independent predictor of CHF, even in persons without preexisting coronary heart disease, diabetes or hypertension. They believe this suggests that microvascular disease may play an important role in the development of heart failure in the general population, and that some asymptomatic persons with retinopathy on an ophthalmologic examination may benefit from further assessment for CHF risk. |
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SOURCE: Wong TY, Rosamond W, Chang PP, et al. Retinopathy and risk of congestive heart failure. JAMA 2005;293(1):63-9. |
Falls and Health
Status in Elderly Women After First Cataract Surgery One-third of elderly people fall each year, and poor vision has been associated with increased risk of falls. The authors of a study conducted at Englands University Hospital, Queens Medical Center, aimed to determine if first eye cataract surgery in women reduces the risk of falling, and to measure associated health gain. The study included 306 women older than 70 with cataract, who were randomized to expedited (approximately four weeks wait) or routine (12 months wait) surgery. Researchers ascertained falls by diary records, with follow-up every three months. They measured health status after six months. In the operated group, visual function improved: corrected binocular acuity improved by 0.25 logMAR units; eight percent had acuity worse than 20/40, compared with 37 percent of controls. Over 12 months of follow-up, 49 percent of operated participants (76 participants) fell at least once, and 18 percent (28 participants) fell more than once. Forty-five percent of unoperated participants (69 participants) fell at least once, 25 percent (38 participants) fell more than once. Rate of falling was reduced by 34 percent in the operated group. Activity, anxiety, depression, confidence, visual disability and handicap all improved in the operated group, compared with the control group. Four participants (three percent) in the operated group had fractures, compared with 12 participants (eight percent) in the control group. |
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SOURCE: Harwood RH, Foss AJ, Osborn F, et al. Falls and health status in elderly women following first eye cataract surgery: a randomized controlled trial. Br J Ophthalmol 2005;89(1):53-9. |
In Vivo Confocal
Microscopy of Keratic Precipitates Researchers at the Casey Eye Institute in Portland, OR, recently conducted a study using in vivo confocal microscopy (IVCM) to describe the architecture and heterogeneity of keratic precipitates (KP) in uveitis. KP were viewed with a scanning confocal microscope in 33 patients seeking care at a tertiary referral uveitis service for immune-mediated and infectious forms of uveitis, including HLA-B27associated uveitis, sarcoidosis, Vogt-Koyanagi-Harada syndrome, juvenile chronic arthritis, Fuchs heterochromic iridocyclitis, cytomegalovirus retinitis, herpes zoster ophthalmicus, ocular toxoplasmosis and idiopathic uveitis. Images were captured and digitalized in real time. Forty-two eyes of 33 patients were examined in this study. Patient ages ranged from 22 to 84 years (mean age, 49.4 years). Seventeen (52 percent) of the patients were women and 16 patients (48 percent) were men. The KP ranged from 10 to 350 µm in diameter. Investigators observed the following absolute and speculative outcomes: KP are markedly heterogeneous and variable as documented by IVCM; KP in individual patients are consistent throughout the cornea; the morphologic features of KP change across time; infectious vs. non-infectious causes of uveitis seem to be readily distinguishable by using IVCM; and KP may have consistency for specific disease states and therefore may have diagnostic importance. The authors believe that their study may mark the first time that IVCM has been used to describe the architecture and heterogeneity of KP in uveitis. They believe that their observations reveal a heterogeneity that cannot be appreciated by conventional slit lamp microscopy. |
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SOURCE: Wertheim MS, Mathers WD, Planck SJ, et al. In vivo confocal microscopy of keratic precipitates. Arch Ophthalmol 2004;122(12):1773-81. |
BRIEFLY
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